Hi,I was wondering if there could be any connection to an extremely elevated d-dimer level and the nodule in my lll lung and now a small nodule in my right breast.Let me start from the beginning. In Dec. 07 I started having chest pain while shopping. I have a hiatal hernia and I really felt like it was probably just acting up, however it was extremely intense and painful and no matter what I did it just wouldn't go away. So I drove myself to the ER. While I was there the pain went away, and I was really embarassed to stay.I didn't want to waste their time.Before leaving they asked if they could at least get an ekg and some labs. So I stayed. They said that the EKG was a little off and that my d-dimer level 18.The emergency room physician treating me said it was the highest one he had ever seen, and that it was crucial that they admit me to run some test to rule out pulmonary effusion. I spent the next 5 days in the hospital getting heart enzymes checked and rechecked(totally normal) as well as daily d-dimers. They contined to stay around 18.I believe they told me that the high normal for their tests was around 1.4. They did chest xray,ultrasounds,ct's. Still the only thing that ever showed up was a small LLL lung nodule. They told me to recheck it in 6 months, which I did and it shows no changes.Since then I have had my baseline mammogram. It showed a "very small nodule in the supcrolateral aspect of the r breast,which appears to be an intramammary lymph node".The Radiologist said it isn't anything to worry about(benign)based on mammo.I'm not setting around worrying too much about it anymore, however now that I have gotten the mammo report back, it has once again instilled within me the slight worry and desire to figure out just what in the world is going on! I am in the medical profession,having worked in a hospital lab for several years and now am on the radiological side of things-and I just don't even have a clue as to what kind of physician to make an appointment with who might be able to answer my questions.I would really appreciate any ideas or suggestions on this matter! Thank you in advance.

Since you've worked in lab before you must realize just how extremely high that D-dimer was. It is strongly suggestive that there had been a clot somewhere during the time (or sometime shortly prior to) when that result came up. However, nodules and clots don't look much alike. What probably should have been done at the time was a VQ scan to determine if there was a clot in your lung at the time. It sounds as though if there as one that it has lysed now, although a senile clot (they sometimes solidify, calcify, or otherwise become almost like a bezoar in the lung) could perhaps be mistaken for a nodule. It seems unlikely, but the VQ scan would have helped tell the story when the chest pain first occurred.

I am a huge advocate of pro-active detection of DVTs and clots and ruling these things out early on so the patient can move on to lesser concerns and not have to remain on edge indefinitely. You now have been determined to have what appear to be a benign breast lump and an equally benign lung nodule. Both should, of course, be followed routinely, but not urgently.

That still leaves the other issue open. The sort of specialist you should probably see now is a hematologist. You'll need to determine whether or not you have an predisposition to clot formation (such as Leiden factor V), and either have those things ruled out or medically managed. There's no sense leaving something like that to chance. If you're hematologically fine then this was probably an isolated, freak instance, but you really should be certain.

That's my best answer to your question. Please follow up with us as needed.

John, I and a lot of other people I'm sure,really appreciate you helping us figure out our healthcare mysteries and concerns. Sometimes we can worry ourselves into a tizzy and just need some perspective! That is why I am writing you again,I need your perspective. I haven't had anymore d-dimers running in the teens I'm happy to report, and I have been following the LLL nodule for one year as recommended. The first and second reports indicated no changes.However I just received my third and final ct report, and I find it troubling. This radiologist reports that the lll nodule remains unchanged as well as the "other ground glass opacities".This is worrisome because neither of the other two radiologist ever reported any other "ground glass opacities".Could you explain to me what this is? I have asked a couple of the radiology techs that I work with and they just tell me it's a texture they see on the images.That makes since but I don't know what they could represent and if I and my nurse practitioner should be concerned about them.I suppose I keep wondering if they really did miss a PE when I was hospitalized for the crazy elevation in d-dimers. My nurse practioner was going to put me on estrogen since I am in my thirties and have had a total hystorectomy. But I am very nervous about it considering the big mystery! I explained to her the whole episode and also I told her that 3 weeks after I was discharged from hospital,I had what looking back-now looks like a TIA(migraine,massively dizzy,couldn't focus or stand-for about 1 hour).I told her I wondered if perhaps the five days of heparin shots was just enough to resolve a missed PE but not enough to totally break it up,and wondered if perhaps I passed a small clot during this headache episdoe.Don't worry I know I don't have DR in front of my name, and basically I know only enough about things like this to probably just confuse myself! Anyway she sent me for a whole slew of coagulation testing,of which none is back yet. Anyway I really do need some perspective on all of this.I don't want to chase after elephants if there really aren't any around-there's already plenty of challenges in my life without making one up!Thanks